Definition: Non-erosive reflux disease (abbreviated as NERD) is generally defined as reflux disease with typical symptoms of esophageal reflux caused by esophageal acid reflux for >3 months without visible mucosal damage on endoscopy, also known as endoscopic negative reflux disease. It is the most common gastroesophageal reflux disease (GERD for short) in clinical practice, accounting for about 50% to 70% of GERD. In recent years, the incidence of NERD has been on the rise year by year, and has become a major digestive disease that seriously affects people’s quality of life, and its impact on physiological function, social function exceeds that of other chronic diseases such as diabetes and hypertension.
Manifestations: The clinical manifestations of NERD take various forms, and esophageal symptoms.
(1) Acid reflux manifested by the effortless reflux of stomach or esophageal contents into the pharynx or mouth without nausea or abdominal contractions, and sometimes bile reflux into the pharynx.
(2) Heartburn or heartburn is a burning-like discomfort behind the sternum, sometimes radiating to the neck, most commonly after meals, and is now thought to be caused by acid irritation of deep sensory nerve endings in the epithelium of the esophageal mucosa.
(3) Chest pain: long-term irritation and damage to the esophagus by acidic gastric contents, which in turn leads to esophagitis; stimulation of the esophagus by H+ causes esophageal contraction, sometimes resembling angina pectoris.
(4) Dysphagia: often due to esophageal spasm, and progressive worsening of dysphagia if esophagitis is accompanied by esophageal stricture.
(5) Bleeding: seen in severe esophagitis and esophageal ulcers, manifested as vomiting blood or black stool. Extra-esophageal symptoms: pharyngitis, stomatitis, tracheobronchitis, bronchial asthma, aspiration pneumonia, clinical manifestations of interstitial fibrosis due to reflux of gastric contents into the pharynx, larynx, oral cavity, and whistling tract, such as: sore throat, hoarseness, cough, sputum, shortness of breath, etc. dysphagia, hoarseness, non-cardiogenic chest pain, and chronic cough.
Etiology: The pathogenesis of reflux esophagitis has not been fully elucidated to date and may be related to an imbalance between defensive factors (anti-reflux barrier, esophageal acid clearance and mucosal resistance) and invasive factors (gastric acid pH, acid secretion and reflux of duodenal contents).
Specifically, these include the following.
(1) decreased lower esophageal sphincter (LES) pressure.
(2) transient lower esophageal sphincter relaxation.
(3) Decreased esophageal clearing capacity.
(4) Impairment of the esophageal mucosal barrier.
(5) Attack of refluxed material.
(6) Esophageal visceral hypersensitivity.
(7) Genetic factors.
(8) neurological endocrine immune network system.
Treatment: Western medicine treats NERD mainly with drugs, which mainly include proton pump inhibitors, such as omeprazole, lansoprazole, rabeprazole, etc.; H2 receptor antagonists, such as cimetidine, ranitidine, etc.; gastric mucosal protective agents, such as aluminum magnesium thiosulfate; however, this non-etiological treatment is only effective for about half of NERD, and has defects such as high relapse rate and the need for long-term medication. Combination medications can improve clinical outcomes, but a significant proportion of NERD patients still do not benefit.
NERD patients are often accompanied by depression and anxiety symptoms, and the efficacy of anxiolytic and depressant drugs in the adjuvant treatment of NERD is clear, but the side effects of these drugs should not be ignored, and long-term repeated use can lead to tolerance and dependence. Therefore, in the treatment of NERD, it is important to assess the degree of anxiety and depression of patients in detail and to weigh the pros and cons of using anti-anxiety and depression medications in order to achieve the best clinical efficacy while minimizing side effects.
Chinese herbal formulas can achieve similar or even surpass the efficacy of PPIs, which are currently the first choice for the treatment of NERD. However, due to the lack of uniform criteria for the identification and typing of NERD, the formulas used also vary, which is not conducive to the standardization of clinical treatment protocols for NERD.
Acupuncture therapy is effective, safe, simple and economical. In recent years, there are more than 2000 clinical and experimental reports on the treatment of functional gastrointestinal disease by acupuncture. In this field, acupuncture therapy has been proven to have the characteristics of multi-path regulation, two-way balance regulation, and the unity of form and spirit, physical and mental treatment, which can regulate the organism from the whole body, and thus has the advantages of fast onset of effect in the near term and stable effect in the long term. In the treatment of functional gastrointestinal disease combined with depression, anxiety and other psychological disorders, acupuncture has a very good performance, Peng Suifeng and other electroacupuncture treatment of functional dyspepsia combined with mental disorders found that the anxiety and depression scores of all patients through acupuncture treatment were significantly improved. However, when these conventional acupuncture points were used to treat NERD in clinical practice, it was found that the current acupuncture treatment protocols for NERD are poorly reproducible and have unstable efficacy; therefore, we need to combine Chinese and Western medical theories and rethink the method of acupuncture point selection.
Dr. Chao-Ming Chen has achieved good results in treating patients with NERD by using the Gui-qi guiding acupuncture method of the Duoyuan meridian. Acupuncture points: Duoyuan meridian positive reaction point, Dazhi, Baihui. Operation of the positive reaction point of the Governor’s meridian: the patient takes a prone position with both upper limbs placed naturally on both sides of the body, the doctor touches the front of the thumb between the two spinous processes of the crest with the front of the thumb, and presses with continuous and even pressure, starting from under the spinous process of the 1st thoracic vertebra and pressing from top to bottom until under the spinous process of the 1st lumbar vertebra, the pressure is positive if there is obvious pain or soreness at the place of pressure, and no pain or no pain can be judged clearly. If there is no clear positive response point, the three points of Zhiyang, Lingtai and Shendao are taken and recorded on the observation table before locating the other points. If the patient has a history of acute or chronic low back pain, the history and physical examination should be used to exclude pseudo-positive reaction points caused by that cause; if they cannot be clearly excluded, the Zhiyang, Shendao, and Lingtai points are taken.